complication of long term ventilation
TRANSCRIPT
COMPLICATION OF LONG TERM MECHENICAL VENTILATION
K.A.S.PRIYANTHAMD/BN/2011/196
B.Sc NursingFaculty of medicine
University of Ruhuna.
MECHANICAL VENTILATION
“A mode of assisted or controlled ventilation using mechanical devices that cycle automatically to generate airway pressure.”
(The American Heritage Medical dictionary)
MECHANICAL VENTILATION
1.Invasive mechanical ventilation.
2.Non-Invasive mechanical ventilation.
Invasive mechanical ventilation
Defined as mechanical ventilation via an artificial airway which can either be via endotracheal tube or tracheostomy tube.
Non-Invasive mechanical ventilation“Noninvasive ventilation (NIV) refers to the administration of ventilatory support without using an invasive artificial airway”
indication1. Acute pulmonary oedema 2. Pneumonia 3. ARDS 4. Severe asthmatic attack 5. Severe acute exacerbation of COPD 6. Guillain-Barre syndrome 7. Myasthenia gravis 8. Drug overdose 9. Shock 10. Severe sepsis
COMPLICATION OF LONG TERM VENTILATION1.INFECTION
PneumoniaOne of the most serious and common risks of being on a ventilator is pneumonia. The breathing tube that's put in the airway can allow bacteria to enter your lungs. As a result,may develop ventilator-associated pneumonia (VAP).
Nosocomial infction(Gram-negative organisms)Enterobcter sppEscherichia coliKlebsiella sppProteus sppPseudomonas aeruginosaAcinetobacter sppStapylococus aureus
2.PNEUMOTHORAX
This is a condition in which air leaks out of the lungs and into the space between the lungs and the chest wall. This can cause pain and shortness of breath, and it may cause one or both lungs to collapse.
3.INJURIES TO FACE, LIPS AND OROPHARYNX
Trauma to the lip and checks from the tube tie.
Injuries to the tongue particularly when entrapped between the endotracheal tube and the lower teeth.
4.LARYNGEAL INJURIES
Some degree of glottic injury is seen in 94% of patients intubated for 4 days or longer
Erosive ulcers of vocal cords.Swelling and edema of the vocal cords.Granulomas (7% in patients intubated for 4
days or more)
5.TRACHEAL INJURIES
Cuff pressure tracheal damage: tracheal ulceration, edema and submucosal hemmorrhage
Tracheal dilatationTracheal stenosis
6.HYPOTENSION
7.GASTROINTESTINAL EFFECTS
Esophagus,Stomach and Small Intestine
Erosive esophagitis (30-50% of patients ventilated >48 hours)NG tubePoor lower esophageal sphincter tone and refluxOpiates and adrenergic agonistsDuodenogastroesophageal reflux through the action of trypsin
Upper gastrointestinal hemorrhage:StressDecreased gastric mucosal protection secondary to a fall in
splanchnic blood flowDecreased motility of stomach and small intestine
Liver and Gallbladder
Reduction in portal venous flow secondary to the fall in cardiac output.
Hepatic engorgement.Reduction in drug clearance secondary to
reduction of hepatic blood flow.
Large Bowel
ConstipationAbdominal distension
8.RENAL EFFECTS
The usual renal response to reduction of cardiac output and mean arterial pressure.
Reduction in urine output secondary to a fall in the transmural pressure of the right atrium that results in reduction of the secretion of atrial naturitic peptide and the activation of renin-angiotensin-aldosterone system and pituitary vasopressin secretion
9.DISRUPT SLEEP
Noise disruptionVentilator alarm:
inappropriate thresholdDelayed alarm inactivation
Humidifier alarmsDisruption by nursing interventions
o Airway suctiono Nebulizer delivery
Ventilation-related pharmacological disruption o Benzodiazepineso Oipoids
10.DECUBITUS ULCERS
11.MALNUTRITION
12.DEPRESSHION & ANXIETY
13.DELEIRIUM